Aggression

How Brain SPECT Imaging Can Help with Aggression

• Help determine the type of aggression to direct treatment
• Identify systems involved with violence and direct treatment
  • Prefrontal – impulsive, poor forethought and judgment
  • Temporal Lobes – dark, violent thoughts
  • Anterior Cingulate – get stuck on thoughts, rigid, inflexible
• Follow up scans to see if the treatment is working at an optimal level
• Help families see the biological nature of aggression to help understand and encourage help
• Optimize brain function before other forms of treatment, such as anger management
• Help motivate treatment
• Help understand difficult behavior
• See if there are other co-occurring conditions that need to be treated such as ADHD or bipolar disorder

Aggressive behavior is often the result of a brain gone wrong. When these brain abnormalities are properly treated there is often significant improvement. There is substantial imaging research on violence, including several studies that we have published from the Amen Clinics.

Violence is not one thing. Our research has shown that there are at least three different types of violence that all require different treatments: impulsive violence (low prefrontal cortex), compulsive violence (high anterior cingulate) and random or senseless violence (temporal lobe). Knowing which type or combination of types is essential to getting the right help.

How do you know unless you look? Brain SPECT imaging is a tool that can be very helpful in the understanding and treatment of aggressive behavior.

Looking at the brain has the potential to increase the effectiveness of diagnosis and to better target treatment. Here is an example:

By age 12 Kris had a long history of emotional outbursts, increased activity level, short attention span, impulsiveness, school problems, frequent lying and aggressive behavior. At age 6 Kris was placed on Ritalin for hyperactivity but he became more aggressive and started to have visual hallucinations, so it was stopped. After he attacked a boy at school, when he was 8 years old, he was admitted to a psychiatric hospital. He was given the diagnosis of depression and started on the antidepressant desipramine. It didn’t help. By the age of 12, Kris had been seen for several years of psychotherapy by a psychiatrist without benefit. Kris’ behavior escalated to the point where he became more aggressive and uncontrollable at home. When he attacked another child at school with a knife he was placed in a psychiatric hospital. With a poor response to multiple other treatments, Dr. Amen ordered a brain SPECT study. Kris’ scan was very abnormal at rest, showing marked decreased activity in the left temporal lobe. When Kris performed the concentration task there was marked decreased activity in the prefrontal cortex.

Given the temporal lobe problems Kris was placed on antiseizure medication as a way to normalize his temporal lobe. When Kris went back to school his behavior was much better but he still struggled academically. Due to the fact that he had two problems (the left temporal lobe disorder and prefrontal cortex shut down) Dr. Amen added a stimulant medication, which helped his attention span and his schoolwork dramatically improved. With the antiseizure medication onboard the stimulant could now work. The positive response to treatment has held for many years.

Kris’ SPECT Images

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Underside at rest decreased prefrontal and left temporal lobe	    Â	Underside with concentration marked decreased prefrontal and left temporal lobe

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